London Region Championships 2020

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London Region Championships 2020

This entry form should only be used by Enfield Swim Squad members.

PAYMENT FOR GALA ENTRIES WILL BE TAKEN BY DIRECT DEBIT. IF YOU HAVE NOT YET SIGNED UP FOR THE ESS GALA DIRECT DEBIT SCHEME, PLEASE DO SO HERE: https://pay.gocardless.com/AL0000NJ5PHFXB.

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Email *

Swimmer's surname *

Please enter SURNAME as registered with Swim England.

Swimmer's FIRST name *

Please enter FIRST name as registered with Swim England.

Date of Birth *

MM

/

DD

/

YYYY

Gender *

Male

Female

Swim England Registration Number *

Go to www.swimmingresults.org/biogs to find your number and check your time. If you do not know your Swim England number, please enter '00000'.

Contact Mobile Number *

50m Free

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

50 Free

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

100m Free

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

100 Free

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

200m Free

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

200 Free

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

400m Free

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

400 Free

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

50m Back

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

50 Back

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

100m Back

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

100 Back

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

200m Back

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

200 Back

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

50m Breast

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

50m Breast

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

100m Breast

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

100m Breast

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

200m Breast

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

200m Breast

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

50m Fly

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

50m Fly

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

100m Fly

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

100m Fly

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

200m Fly

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

200m Fly

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

200m IM

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

200m IM

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

400m IM

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

400m IM

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

800m Free

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

800m Free

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

1500m Free

If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.

1500m Free

Please confirm whether the entered time has been achieved in a 25-metre Short Course (SCM) or in a 50-metre Long Course (LCM) pool.

Name of your squad: *

I CERTIFY THAT ALL TIMES AND DATA ARE ACCURATE AT TIME OF SUBMISSION. I AUTHORISE ESS TO COLLECT THE RELEVANT EVENT ENTRY FEES VIA DIRECT DEBIT. *

Please see gala conditions for detail of entry fees. ESS will charge an additional £1 per swimmer to cover admin cost. IF YOU HAVE NOT YET SIGNED UP FOR THE ESS GALA DIRECT DEBIT SCHEME, PLEASE DO SO HERE: https://pay.gocardless.com/AL0000NJ5PHFXB.

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